CARE HOME ADULTS 18-65
Boundary House Haveringland Road Felthorpe Norwich Norfolk NR10 4BZ Lead Inspector
Mr Jerry Crehan Announced Inspection 12th January 2006 12:00 Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Boundary House Address Haveringland Road Felthorpe Norwich Norfolk NR10 4BZ 01603 754715 01603 400418 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Canabady Mauree Ms Sandra Bridgwood Mrs Emma Louise Hopkins Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Home may accommodate up to ten (10) people who have a Learning Disability, one of whom is over 65 years of age and is named in the Commission`s re cords. 16th August 2005 Date of last inspection Brief Description of the Service: The Boundary House provides residential care for up to 10 adults with learning disabilities, it is situated on the outskirts of the village of Felthorpe, which is a few miles from the city of Norwich. The home is situated in extensive grounds containing portacabins, greenhouses and other outbuildings. Bedrooms are located on the ground and first floors. There are communal lounge, dining and kitchen areas. There are two bathrooms and one shower room. Service users living in the home access day services, including those operated by the proprietor in North Walsham. The home has its own transport. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 5 hours. Opportunity was taken to tour the internal and external premises, look at care records and policies, and communicate with or observe several of the ten service users accommodated at the time of the inspection. Staff members and the manager were also spoken to. The home is commended for its promotion of comment cards prior to the inspection. A total of fourteen comment cards were received from service users, relatives and visiting professionals. These were broadly favourable about the service provided by the home. Other issues of relevance raised within comment cards were addressed within the inspection. What the service does well: What has improved since the last inspection?
Several new staff have been appointed since the last inspection, resulting in a greatly reduced reliance on agency carers at the home. New care staff are evidently enthusiastic and interested in their work with service users. The new care staff have been supported by thorough induction training and support by the manager and from colleagues, and consequently appear well aware of their responsibilities. It is hoped that the recent appointment of a training manager will further improve the training outcomes for experienced and for newer staff at the home. Work on accessible formats for documentation for service users including the complaints procedure and the service user guide is encouraging, as is work on policy and procedure review involving service users. The premises have been improved since the last inspection with replacement windows and redecoration to the exterior. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Information about the service provides prospective service users with the information they need and is supported by relevant assessment practice by the home. EVIDENCE: The Boundary House provides clear information that would enable prospective service users to make an informed choice as to whether and how the home could meet their needs. Information can be made available in other formats to suit individual communication requirements; evidence of this was seen during the inspection. In addition to assessments undertaken by placing authorities detailed assessments have been completed by the home that address service users aspirations and needs. Individual contracts setting out terms and conditions of residence, including fee’s were evident in service users files seen. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 & 10 There is a good care planning system in place that enables service users to participate in aspects of life. Independence is promoted through good care planning and assessment of risk. EVIDENCE: Care plans seen accurately reflected information gathered within assessments and provide staff with the information they need to meet individual need. Care plans also contain individual target and goal setting. Service users were not necessarily familiar with their individual plans, however, evidence of work towards achieving goals was seen as service users participated in household activities, eating and personal care tasks. Individual risk assessments are undertaken at the home to support the independence of service users. It was evident that service users are supported in making decisions about aspects of life within the home. Staff were observed in supporting service users to make decisions and choices by presenting available options. Confidentiality issues are evidently understood at the home. There are secure arrangements for the storage of records. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 13, & 17 Opportunities for personal development are provided. Meals at the home offer choice and variety according to preference. Links with the community are supported. EVIDENCE: The majority of service users at the home attend off site day services operated by the proprietor. However, the home supports preferred alternatives. A service user at the home aspires to live more independently and to manage more of their affairs, with support. They have been supported by the home in developing practical and independent life skills. Other service users were observed in participating in individual and communal household tasks. Activities available to service users include, shopping trips, trips to the pub, trips out at weekends and participation in a weekly social club. Transport is available at the home from its two vehicles. Care staff at the home prepare meals. It was evident that menu setting was a joint activity, and based on individual preferences (and dietary need). Service users spoke favourably about the food at the home. Mealtimes are a communal activity at the home, though are sometimes staggered to meet individual need and preference.
Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20 Service users personal and healthcare needs, including medication, are well attended to. EVIDENCE: Records reviewed indicate that service users health is monitored and that access to community health professionals is supported where necessary. Visiting professionals were seen at the time of the inspection. There are no service users accommodated at the home who have responsibility for their own medication. On review of medication records no discrepancies were identified, and storage arrangements are good. There was evidence of medication review and consultation with G.P’s and others. There are clear guidelines set out for staff in respect of medications to be administered when required (PRN). Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home’s complaints system is satisfactory. EVIDENCE: The home has a detailed complaints procedure that is on display. The manager indicated that a summary of this is currently being adapted to be made available in other accessible formats for service users. However, service users spoken to appeared clear that if they had a concern or complaint they would either speak with staff or the manager. The home operates a complaints book for more minor issues. These records were seen and include action to be taken by the manager to address the issue. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26, 28, 29 The home is well equipped to meet the needs of its service users and provides a reasonable standard of accommodation. EVIDENCE: Service users are supported in personalising their bedrooms to reflect individual tastes and preferences. Every bedroom is lockable and has a lockable storage facility for safe storage of belongings. Some service users have elected to look after their own room keys. The home has a large lounge/ dining room that provides access to the substantial rear garden area. The home has adequate shared space for service users to participate in communal activities, but is restricted in communal private or quiet areas. There is a designated smoking area outside. The premises have been improved since the last inspection with replacement windows and redecoration to the exterior. The home has a number of suitably positioned grab rails and a ramp to the main entrance to the home is the only required environmental adaptations. One service user has access to their own wheelchair for occasional use. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 Staff at the home are well supported and employed in sufficient needs to meet the service users needs. Staff training is in place but not yet fully satisfactory. EVIDENCE: Staff have clearly defined job descriptions and training that are linked to achieving goals for service users. Staff seen were clear about their role and responsibilities to service users. Service users spoke favourably about the staff group at the home. Staff rotas indicate the deployment of sufficient staff to meet service user need. There is a core group of sixteen care staff at the home, supported and overseen by the registered manager. Some agency carers are used at the home, however, agencies used by the proprietor have been able to provide continuity of staff consequently they are usually familiar with the needs of service users and the policies of the home. There are currently two care staff with NVQ level 2 or above, falling short of the 50 requirement by 2005. However, it is acknowledged that there are a significant proportion of new care staff to the home and that a number have registered to undertake NVQ training. The proprietor has appointed a training manager for the service since the last inspection to oversee NVQ and a range of other training. Staff files looked at showed that service users are protected by good recruitment practices.
Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 15 Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 40, 42, 43 Service users are supported by appropriate policies, procedures and are supported to make a contribution toward their review and development. Monitoring visits required by regulation does not support quality monitoring at the home. EVIDENCE: The views of service users are sought on every day issues associated with the running of the home, and the manager indicated that the views of service users will also be sought in a forthcoming review of the home’s policies and procedures. The Commission has not received required monthly monitoring reports from the Proprietor required by regulation. A range of appropriate policies and procedures developed by the proprietor satisfactorily safeguard service users and are reflective of National Minimum Standards. The home demonstrates good practices ensuring service users health, safety and welfare. Relevant health and safety training for staff, including moving and handling, first aid, fire and food hygiene training, support practices.
Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 17 There are no issues of concern associated with the effectiveness, financial viability or accountability at the home. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X 3 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score X X 3 X 3 3 X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 2 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Boundary House Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 2 3 X 3 3 DS0000027402.V268724.R01.S.doc Version 5.0 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA39 Regulation 26 Requirement The registered person must ensure that monthly monitoring visits to the home are carried out. Timescale for action 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA32 Good Practice Recommendations It is recommended that the registered person ensure progress toward meeting the 50 NVQ training requirement. Boundary House DS0000027402.V268724.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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